[Neuropsychological disorders in multiple sclerosis]. / Neuropsychologische Störungen bei Multipler Sklerose.

In multiple sclerosis (MS) neuropsychological disorders such as cognitive dysfunctions, depression, and fatigue are common and have a significant impact on everyday live. The three symptoms interact in different ways which has to be bore in mind in diagnostic and therapeutic proceedings. The clinical management of the three symptoms should include an assessment of overlapping cofactors and primary causes as well as a step-wise treatment approach that encompasses non-pharmacological and pharmacological interventions.

Complementary and alternative medicine and coping in neuroimmunological diseases.

The utilisation of complementary and alternative medicine (CAM) is widespread in neuroimmunological diseases like multiple sclerosis (MS) but has been disregarded in research until lately. After describing the problems of definition in CAM, different categories will be described. Various confounding factors on CAM utilisation exist, though hardly investigated. Besides sociodemographic variables like education, income, gender and age, illness-related factors like severity of disease are discussed. Furthermore, the important role of coping and CAM utilisation has not been investigated in neuroimmunological diseases, yet. Results derived from our investigations on CAM utilisation in MS indicate that users of CAM apply coping strategies, such as "rumination", "search for information" and "search for meaning in religion", more frequently than non-users and that current CAM utilisation is related to depression. Further research is needed in this field, as well as in other neuroimmunological diseases.

[Diagnostic of cognitive dysfunctions in multiple sclerosis]. / Diagnostik kognitiver Defizite bei Multipler Sklerose.

Cognitive dysfunctions are frequent symptoms in multiple sclerosis (MS). Up to 65% of the patients suffer from cognitive dysfunctions. Especially memory, attention and executive functions are impaired. These problems strongly affect the patients' ability to work and their quality of life. A differentiating diagnostic effort is necessary to control fatigue and depression. Screening tools alone cannot provide a detailed description of all cognitive domains. Therefore, an elaborated neuropsychological diagnostic is necessary. This report provides a description of cognitive functions and its diagnostic opportunities, especially in MS patients. After displaying aspects of differential diagnostics, a recommendation for a diagnostic work schedule is given.

Validation of the Addenbrooke's cognitive examination for detecting early Alzheimer's disease and mild vascular dementia in a German population.

We assessed the diagnostic accuracy of the German version of the Addenbrooke's Cognitive Examination (ACE) in identifying early Alzheimer's disease (AD) and mild vascular dementia (VaD) in comparison with the conventional Mini-Mental State Examination (MMSE). The study refers to 50 patients with mild dementia of AD, 26 patients with mild dementia of vascular etiology and to 54 cognitively normal subjects. The ACE and MMSE were validated against an expert diagnosis based on a comprehensive diagnostic workup. Statistical analysis was performed using the receiver operator characteristics method. The optimal cut-off score for the ACE for detecting dementia in patients with early AD was 85/86, which had a sensitivity of 93% and a specificity of 86%. The optimal cut-off for the ACE for the identification of dementia in patients with mild VaD was also 85/86 and it had a sensitivity of 93% and a specificity of 100%. The kappa values imply a substantial agreement between the diagnoses made by the ACE and the MMSE. The German version of the ACE is a short and practical but accurate test battery for the identification of AD and VaD, assessing a broad range of cognitive functions and providing a wide profile of cognitive functions/dysfunctions.

[Cognitive dysfunctions in multiple sclerosis patients]. / Kognitive Defizite bei Multipler Sklerose.

Cognitive dysfunctions are frequent symptoms of multiple sclerosis (MS) and occur in up to 65% of patients. Especially memory, attention, executive and visual constructive functions are impaired. These problems strongly affect patients' ability to work, social relationships, and quality of life. Symptoms of physical disabilities can arise independently. Cognitive dysfunctions are clear indicators of MS progression, since they represent highly complex functions depending on the integrity of neuronal networks. Once manifested after a relapse, they remain stable. Given a differentiating diagnosis, it is possible to treat these dysfunctions by cognitive training and pharmacologically for example by immunomodulating drugs. However, treatment options are limited at present. This report provides a detailed description of cognitive functions and performance in MS patients, their comorbidities such as fatigue and depression, currently available diagnostic tools, and therapeutic options.